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Click ‘Get Form’ to open the gl3410e form in the editor.
Begin by filling out the 'Plan Sponsor' section. Clearly print the company name, address, and contact information. Ensure you include the plan contract number and division number.
Proceed to the 'Plan Member Identification' section. Enter the plan member's name, certificate number, date of hire, and job title. Specify their work hours and reason for stopping work.
In the 'Plan Member's Earnings and Benefit Information' section, report all sources of income accurately. This includes base salary, commissions, and any other applicable earnings.
Complete the 'Work Information' section by detailing job requirements and physical demands. If available, attach a physical demands analysis.
Finally, review all entries for accuracy before signing at the declaration section. Once completed, save your document.

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Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (30 Votes)
2005	4.6 Satisfied (37 Votes)

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What is a plan sponsor statement?

The information on the Plan Sponsors Statement is for the assessment of the plan members absence from work under: The Short-Term Disability (STD) plan and where applicable, The Long-Term Disability (LTD) plan. This statement forms part of the plan members disability claims file.

What is an example of a plan sponsor?

Employers are typically plan sponsors, but unions and professional bodies could also be plan sponsors.

What is meant by plan sponsor?

A Plan Sponsor refers to the organization or entity that establishes, maintains, and offers a benefits plan, such as a health insurance plan, retirement savings plan, or other employee benefit programs, for its members, employees, or participants.